Nutchaya Doloh, the senior health officer at Ban Talonaeng Health Center in Narathiwat, Thailand, prepares a vaccine during the clinic’s weekly vaccination program this week. Globe and Mail reporter Nathan VanderKlippe’s investigation into the resurgence of measles in North America brought him as far as southern Thailand, where public health authorities are trying to fight low vaccination rates.Lauren DeCicca/The Globe and Mail
For most of the past millennium in which it spread, the measles was an implacable, unstoppable foe.
The 1950s-era vaccine that halted its advance was, then, a victory for humanity, a banner-holder for science and progress. A World Health Organization-funded report published in the Lancet last year found the measles jab alone averted more than 60 per cent of the 154 million deaths saved by vaccines in the past half-century.
So what does it mean when that progress slows?
How does North America find itself back in the throes of measles outbreaks, nearly three decades after eliminating the virus? How is it that Canada, one of the most eager first adopters of that vaccine, now stands at the heart of this new measles moment?
As case counts began to grow last fall, public health authorities in Canada gave only rudimentary answers to that question, pointing to an infected international traveller who flew across Canada to New Brunswick to attend a large gathering last October. From there, measles outbreaks erupted across the continent – and down through the Americas.
But how did this viral blaze ignite?
The story: How the measles made its way back to Canada and threatened our victory over the virus
This was the question I set out to answer. As I began my reporting to trace the path of the virus, I was warned that this would not be easy. Some of the communities struck by measles had felt unfairly condemned for their reluctance to vaccinate. Some were wary of outsiders. Some harboured deep conspiracy theories they didn’t want to discuss publicly.
My goal, from the outset, was to understand rather than judge. The reasons behind peoples’ medical decisions can be intensely personal. The balance of individual and public good has never been fixed – it is constantly being negotiated by changing circumstances and shifting evaluations of risk. Besides, rates of public vaccination are already available to anyone with the inclination to look.
What wasn’t known was how this particular series of outbreaks began. In some places, such as Texas, which had the largest number of U.S. cases, not even public health authorities could answer that question.
Warning signage for suspected cases of measles outside the main entrance of Ontario’s Woodstock General Hospital in May.Nicole Osborne/The Canadian Press
I started my search this summer, first in New Brunswick, where initial cases were reported last October. It wasn’t clear who I should speak with, and I soon discovered that local political authorities had either been starved of information, or had no interest in obtaining it. One mayor said he had no clue who in his community had been sick. Another said he had received no information from the government.
Margaret Johnson, a local MLA, told me: “Somebody got sick and went to the ER.”
“It was a perfect storm,” she added. “You’ve got someone coming in that’s sick with a highly contagious disease.”
She, though, was similarly in the dark about how the measles took hold here.
But someone must have known. People got sick, some seriously. It turned out the answers were close at hand.
Just three kilometres from Ms. Johnson’s office in Centreville, N.B., I drove onto a farm. I had been pointed here by a local woman who was, as I was, intrigued about how this had all happened. She asked around, and suggested I speak with the Villeneuves.
Measles resurgence exposes fault lines over vaccines and faith in Alberta town
I arrived unannounced, and drove up to meet three generations of the family who happened to be outside.
After explaining who I was and what I was doing, I told them: “I think it started in this area.”
Their answer surprised me.
“It started,” said an older woman, “with our daughter.”
She introduced herself as Sylvie Villeneuve, and began to tell me more.
Many people in her family had gotten sick after a wedding, at least two so seriously they feared for their survival. The family did its best to halt the spread, closing the doors to businesses and suspending church services for weeks.
But it had taken doctors five days to determine that her daughter was sick with the measles. By that time, the virus was already making its way across the continent.
I set out to follow it. Many of those at the wedding had returned home to Ontario, so that link was clear. But how did it then get to Texas?
To find out, I flew to Seminole, the city in Texas where hundreds of people had gotten sick. I soon found out that not even local health authorities could explain how the measles arrived. I knocked on doors, stopped by churches, visited schools, interviewed doctors.
Nancy Ginter owns Health 2 U, a local store stocked with health-food products, in Seminole, Tex.The Globe and Mail
Finally, I found one woman who agreed to speak with me. Nancy Ginter runs a health-food store, and had information that the medical establishment did not. She showed me pictures on her phone of children with rashes, sent to her by parents unsure what to do. And she told me how she had learned about visitors exposed to measles who had come to Texas for Christmas, weeks before any hospital had made a diagnosis.
Those visitors, she was told by customers to her store, had come from Canada.
It was another piece in the puzzle. But the biggest one remained. Where exactly had this come from? Where was it before the wedding in New Brunswick? The answer to that lay on the other side of the Pacific in Thailand, where I met Sylvie’s daughter, Lea – who, like her mother, was warm and open. Lea was staggered at the part she had inadvertently played, as a carrier of a virus between Asia and North America.
“It still baffles me that I could have gone there with this virus in me – and look where it is now,” she said. “I felt so bad.”
“Tell everyone we’re sorry,” her husband added. “We never would have travelled if we would have known that we would have been the case.”
Ultimately, they had been caught up in something much bigger, a measles outbreak in the area where they live, but also a much longer arc of change.
Lea Knelsen photographed with her family in Narathiwat, Thailand, in July. When she flew to Canada for a wedding last year, she did not know she was sick with the measles.Nathan VanderKlippe/The Globe and Mail
“This actually starts way before the pandemic – in 2019,” Shelly Bolotin, director of the Centre for Vaccine Preventable Diseases at the University of Toronto, told me. That year saw an early global resurgence of measles. Those cases diminished as the world came to a standstill during the pandemic. But gaps exposed by waning vaccine coverage remained, and in some cases were worsened by peoples’ experiences with COVID-19.
Either way, “what we’re seeing in Canada is a symptom of what’s happening in the rest of the world,” Ms. Bolotin said.
This, then, is more than a narrative of one outbreak. It’s also a story of our time, of a re-evaluation of traditional sources of authority, of the limitations of communal action – particularly when that action is coerced – and of the very idea of progress itself.